title: Anterior sagittal approach without splitting the rectal wall.
abstract: BACKGROUND
  The anterior sagittal transrectal approach (ASTRA) has already become popular to treat lesions in the proximal urethra such as trauma, duplicity and stenosis, prostatic utricle, urethral-vaginal fistulas and urogenital sinus anomalies. It provides much better exposure than the traditional perineal approach. Morbidity caused by this technique could be potentially decreased if the anterior sagittal access were to be made without sectioning the rectum. We report our initial experience using anterior approach without rectal sectioning for the treatment of three different types of pelvic disorders.
  
  
  METHODS
  Anterior sagittal access without sectioning the rectal wall was carried out in three different clinical cases - a vaginoplasty in a female patient with congenital adrenal hyperplasia; to treat paradoxical urinary incontinence in a patient with proximal hypospadias (46XY karyotype) and another one with gonadal dysgenesis (46XO/XY karyotype).
  
  
  CONCLUSIONS
  Several surgical techniques have been reported to repair congenital or acquired lesions in the posterior urethra with high morbidity and no guarantees of adequate and safe surgical exposition. ASTRA provides an excellent exposure, splitting only the anterior rectal wall. In this study, the anterior sagittal approach was applied without splitting the rectal wall to repair different posterior urethral anomalies, providing excellent exposure without compromising the fecal continence mechanism.
  
  
  CONCLUSIONS
  The anterior sagittal approach without splitting the rectum is a feasible procedure which provides excellent exposure to the posterior urethra in most cases and leads to less morbidity as it avoids the splitting and suturing of the rectum anterior wall.
authors.affiliation: Pediatric Surgery - Federal University of São Paulo, Rua Coronel Lisboa, 687 04025-001 Vila Clemetino, São Paulo, SP, Brazil. Electronic address: mtorii@uol.com.br.
authors.forename: Mila Torii Corrêa
authors.initials: MT
authors.lastname: Leite
authors.forename: Camila Girardi
authors.initials: CG
authors.lastname: Fachin
authors.forename: Renato Frota
authors.initials: RF
authors.lastname: de Albuquerque Maranhão
authors.forename: Márcia Emília Francisco
authors.initials: ME
authors.lastname: Shida
authors.forename: José Luiz
authors.initials: JL
authors.lastname: Martins
keywords: Child; Patient positioning; Urogenital abnormalities